Get the free Direct Access Endoscopy Referral - med umich

This form is used to refer patients for endoscopy procedures such as colonoscopy, upper endoscopy (EGD), and sigmoidoscopy at the University of Michigan Health System. It includes sections for patient

How to fill out direct access endoscopy referral

How to fill out Direct Access Endoscopy Referral

1. Start by obtaining the Direct Access Endoscopy Referral form from your healthcare provider's office or online portal.
2. Fill in the patient’s personal details, including full name, date of birth, address, and contact information.
3. Provide the patient's medical history, including any previous gastrointestinal issues or surgeries.
4. Include current medications and any allergies the patient may have.
5. Clearly state the reason for the referral, specifying any symptoms the patient is experiencing.
6. Ensure all required clinical information and relevant examination findings are documented.
7. Sign and date the referral form, acknowledging that the information provided is accurate.
8. Submit the completed form to the appropriate endoscopy unit or department as instructed.

Who needs Direct Access Endoscopy Referral?

1. Patients experiencing gastrointestinal symptoms such as persistent abdominal pain, unexplained weight loss, difficulty swallowing, or gastrointestinal bleeding.
2. Individuals with a family history of gastrointestinal diseases who need screening.
3. Patients requiring follow-up evaluation for previously diagnosed gastrointestinal conditions.

People Also Ask about

What is the difference between OGD and endoscopy?

The procedure is called OesophagoGastroDuodenoscopy (OGD) known more simply as gastroscopy or endoscopy. It involves looking at the upper part of the gut which includes the oesophagus (food pipe), stomach and the first part of your small (duodenum) with a narrow flexible tube called a gastroscope.

What is a direct endoscopy?

Direct access endoscopy is a straight-to-test diagnostic service allowing patients to refer themselves for upper or lower gastrointestinal (GI) endoscopy without a prior GI consultation.

Do I need a referral for an endoscopy?

You can directly schedule your appointment with our Upper Endoscopy Specialist. No referral is needed for expert care and diagnosis.

What is a direct access gastrointestinal endoscopy?

Direct-access endoscopy allows patients who meet certain criteria to be directly referred for a procedure (gastroscopy, colonoscopy) by their GP, without having to have a formal consultation with the gastroenterologist.

What is a direct access endoscopy?

Direct-access endoscopy allows patients who meet certain criteria to be directly referred for a procedure (gastroscopy, colonoscopy) by their GP, without having to have a formal consultation with the gastroenterologist.

How do you get referred for an endoscopy?

Your GP may refer you for an endoscopy if you're having certain symptoms. It will usually be done at an endoscopy unit in a hospital. There are different types of endoscopy that look at different parts of the body. The type of endoscopy you have will depend on your symptoms.

What is the difference between OGD and endoscopy?

The procedure is called OesophagoGastroDuodenoscopy (OGD) known more simply as gastroscopy or endoscopy. It involves looking at the upper part of the gut which includes the oesophagus (food pipe), stomach and the first part of your small (duodenum) with a narrow flexible tube called a gastroscope.

What is the difference between direct and indirect endoscopy?

With direct video endoscopy, the microchip camera is mounted on the distal tip of the endoscope; with indirect video endoscopy, a miniature camera is coupled to the eyepiece of a standard fiberoptic endoscope.

For pdfFiller’s FAQs

What is Direct Access Endoscopy Referral?

Direct Access Endoscopy Referral is a process that allows patients to be directly referred for endoscopic procedures without the need for an initial consultation with a specialist, streamlining the pathway for diagnostic or therapeutic interventions.

Who is required to file Direct Access Endoscopy Referral?

Healthcare providers, such as primary care physicians or nurse practitioners, are typically required to file Direct Access Endoscopy Referrals on behalf of the patients needing endoscopic evaluations.

How to fill out Direct Access Endoscopy Referral?

To fill out a Direct Access Endoscopy Referral, the referring provider must complete the referral form with patient information, clinical indications for the procedure, relevant medical history, and any required patient consent before submitting it to the endoscopy unit.

What is the purpose of Direct Access Endoscopy Referral?

The purpose of Direct Access Endoscopy Referral is to facilitate timely access to diagnostic procedures, improve patient care by reducing waiting times, and enhance the efficiency of healthcare delivery.

What information must be reported on Direct Access Endoscopy Referral?

The information that must be reported on a Direct Access Endoscopy Referral includes the patient's personal details (name, date of birth), clinical symptoms, previous medical history, medications, and any special instructions or considerations for the endoscopy team.